Objective: Aortic prosthetic graft infection remains a highly fatal
surgical complication. Recent studies with cryopreserved allografts in
the treatment of vascular graft infection suggest improved clinical
outcomes. The purpose of this study was to evaluate the efficacy of
cryopreserved aortic allografts in the treatment of infected prosthetic
grafts or mycotic aneurysms.
Methods: Clinical data of all patients who underwent in situ aortic
reconstruction with cryopreserved allografts for either infected aortic
prosthetic graft or mycotic aneurysms from 1999 to 2003 were reviewed.
Relevant clinical variables and treatment outcomes were analyzed.
Results: A total of 18 patients (14 men; overall mean age 62 ± 12
years, range 41-72 years) were identified during this study period.
Treatment indications include 12 primary aortic graft infections (67%),
four mycotic aneurysms (22%), and two aortoenteric erosions (11%).
Transabdominal and thoracoabdominal approaches were used in
14 (78%) and four patients (22%), respectively. Staphylococcus aureus
was the most commonly identified organism (n = 11, 61%). Although
there was no intraoperative death, the 30-day operative mortality was
17% (3/18). There were nine (50%) non-fatal complications including
local wound infection (n = 3), lower extremity deep venous thrombosis
(n = 2), amputation (n = 2), and renal failure requiring hemodialysis
(n = 2). The average length of their hospital stay was 16.4 ± 7 days.
During a mean follow-up period of 8.3 months, reoperation for allograft
revision was necessary in one patient due to graft thrombosis. The overall
treatment mortality rate was 22% (4/18).
Conclusion: In situ aortic reconstruction with cryopreserved
allografts is an acceptable treatment modality in patients with infected
aortic prosthetic graft or mycotic aneurysms. Our study showed that
mid-term graft-related complications such as reinfection or aneurysmal
degeneration remained uncommon.